Provider Demographics
NPI:1851284723
Name:WALKER, STACEY RENEE
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:RENEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W BURLINGTON AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1656
Mailing Address - Country:US
Mailing Address - Phone:773-930-5869
Mailing Address - Fax:
Practice Address - Street 1:320 W BURLINGTON AVE APT 2E
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1656
Practice Address - Country:US
Practice Address - Phone:773-930-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist